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7 ACTIVE APPROACH DOES NOT ADD TO THE EFFECTS OF IN VIVO EXPOSURE 165 INTRODUCTION Cognitive behavior therapy (CBT), in particular, Exposure and Response Prevention (ERP) is a highly effective treatment for anxiety disorders (Gunter & Whittal, 2010; Shafran et al., 2009). The defining element of ERP is repeated confrontation with the feared, but innocuous, stimulus (exposure) without avoidance/escape (response prevention). The beneficial effects can be explained in terms of extinction: Patients learn that an anticipated catastrophe does not occur after exposure to a feared stimulus, e.g., people with spider phobia may learn that a spider will not attack them, and people with agoraphobia may learn that busy places do not result in fainting. Exposure to a feared stimulus is regularly established by the patient actively approaching it. There are various reasons to believe that approach behavior may be relevant to the understanding of the beneficial effects of ERP, which is an empirical issue that will be tested in the current experiment. Several lines of research indicate a reciprocal influence between motor behavior and cognition, stimulus evaluation, and affect (see Neumann, Förster, & Strack, 2003; Strack & Deutsch, 2004). Positive evaluations lead to approach tendencies, and negative evaluations lead to avoidance tendencies (Chen & Bargh, 1999). Conversely, perceived movements away from a stimulus trigger the avoidance system and thereby facilitate the processing of negative affective concepts, whereas perceived movements toward a stimulus trigger the approach system and thereby facilitate the processing of positive affective concepts (Neumann & Strack, 2000). For example, arm flexion or having the impression of moving toward a computer screen led to faster categorization of positive words compared to negative words, whereas arm extension or moving away from the computer screen had the opposite effect (Neumann & Strack, 2000). This reciprocal influence can be explained by an implicit, or automatic (De Houwer, 2006), bidirectional link between behavior and motivational orientation (Strack & Deutsch, 2004). Motivational orientation is determined by the valence of